Deep venous thrombosis; mean platelet volume, D-Dimer and doppler sonography. patients of surgical wards of liaquat university hospital

Objectives: To study mean platelet volume [MPV] in deep venous thrombosis [DVT] as evaluated by D-Dimmer and Doppler sonography. Study Design: Case control study. Place and Duration: Department of Surgery, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad from May 2013 to April 2014

Subjects and Methods: A sample of 106 subjects; 50 controls and 53 diagnosed patients of DVT were studied. DVT patients were included according to inclusion and exclusion criteria and after results of Sonography and D-Dimer were available. The Blood samples were collected in bottles containing sodium citrate as anticoagulant. MPV was generated by Sysmex KX 21 hematology analyzer. Informed consent was sought from the volunteer subjects. The Data was analyzed using SPSS version 21.0. Statistically significance was defined at p-value of

Results: Mean platelet volume was elevated in deep venous thrombosis patients which were confirmed by clinical examination, sonography and D-Dimer. MPV was elevated in cases; 10.0 +/- 0.7fl compared to controls; 9.55 +/- 0.63fl [p=0.001]. D-Dimmer was elevated in deep venous thrombosis patients [p=0.0001]. Age, gender and platelet counts did not revealed any significant differences between cases and controls [p>0.0.05]

Conclusion: The present study reports elevated MPV in patients suffering from deep venous thrombosis and it is concluded that MPV may be considered as a risk factor for DVT

Analysis of 200 cases of tube thoracostomies performed by general surgeons

OBJECTIVE OF STUDY: To observe various indications and complications of tube Thoracostomy

DESIGN: Prospective, descriptive study

PLACE and DURATION OF STUDY: Public and private sector hospitals of Nawabshah and Hyderabad from 1[st] Jan 2005 to Dec 2008

METHODOLOGY: All patients of either sex above the age of 13 years having pathology related to chest cavity and underwent chest intubation were included in the study. Patients below the age of 13 years, having serious co morbid illness like Ischemic heart disease [ASA-3], severe chronic obstructive airway disease requiring ventilator support, and complicated chronic liver disease and patients who lost to follow-up were excluded. Data was collected for age, sex, indications of chest intubations, cause of the disease, procedural and post procedural complications and hospital stay. Descriptive analysis was performed using SPSS version 10 for continuous and frequency variables

RESULTS: Total 200 patients of different pathologies related to chest cavity underwent chest intubations. Mean age was 43.57 years SD+/- 12.68 with 60.5% male and 39.5% female. Indications were: pleural effusion 86[43%] patients, pneumothorax 36[18%] patients, empyema thoracis 33[16.5%] patients, hydropneumothorax 24[12%] patients and haemothorax 18[9%] patients

Etiology for intubations includes 118[59%] patients of complicated pulmonary tuberculosis, 27[13.5%] patients of blunt trauma chest and 21[10.5%] patients of post pneumonic empyema

Procedural complications were found in 24[12%] patients and postoperative complications in 25 [12.5%] patients. Mean hospital stay was 5.5 days

CONCLUSION: We found chest tube insertion as the first line of treatment for variety of life threatening chest diseases. It is safe and effective procedure associated with procedural [12%] and post procedural complications [12.5%] which are comparable to international literature

Effectiveness of Limberg flap in recurrent chronic pilonidal sinus disease

To describe outcome of Limberg flap in chronic recurrent pilonidal sinus disease. Case series. This study was done at Surgical Unit-3, Liaquat University Hospital, Hyderabad [LUMHS] from February 2005 to March 2012.Through sampling of convenience all patients irrespective of age and gender with chronic recurrent pionidal sinus disease were included. During the study period 25 patients were enrolled. Two patients were lost to follow-up and were excluded from final analysis. All 23 patients were males, with mean age of 27 year. The mean operative time was 52 minutes and mean hospital stay of 7 days. None of the patients developed flap failure. No recurrence was noted for a mean follow up period of 10 months [range 9-12 months] The Limberg flap for recurrent chronic pilonidal sinus disease was safe and easy to perform procedure with minimum morbidity and early recovery

Experience of laparoscopic cholecystectomy during a steep learning curve at a university hospital

Cholelithiasis is the most common disease of alimentary tract affecting the adult population globally and our country in particular is no exception to it as a cause of hospitalization. Surgical removal of gall bladder is the main stay of symptomatic cholelithiasis ensuring a permanent cure. The minimally invasive technique of laparoscopic cholecystectomy has gained wide acceptance as a Gold Standard treatment ever since its introduction. The purpose of this prospective observational study was to document our experience of laparoscopic Cholecystectomy during a learning curve in a single unit of a university hospital and compare it with other available data in the literature. Total 94 patients underwent laparoscopic cholecystectomy during the learning curve from Jan 2009 to Dec 2010 in the Department of Surgery Liaquat University Hospital Jamshoro. Mean age was 42 years with females [88.29%] preponderance. Majority of the cases were operated by consultants [85.10%] within 25-60 minutes. Postoperative hospital stay was 3 days with return to work in 7 days. Only 6 [6.38%] cases were converted to open technique. Intra-peritoneal drains and Foley's catheter were kept in selected cases only. Eleven patients [11.70%] had intra-operative complications including complete transaction of CBD in only one [1.06%] male patient. Five patients [5.31%] had postoperative complications with two patients having iatrogenic duodenal injury which was not identified during surgery and pseudo cyst pancreas. Four patients [4.25%] died due to multiple organ failure. We conclude that Laparoscopic Cholecystectomy is a gold standard procedure and should be learned on virtual simulated models before starting this procedure on human patients.

Role of investigations and Alvarado score in acute appendicitis at peoples medical college hospital Nawabshah

Role of investigations and Alvarado score in acute appendicitis at Peoples Medical College Hospital Nawabshah. Prospective observational study. Two years study from October 2008 to November 2010. Was conducted in Peoples Medical College Nawabshah. The study comprises 50 patients all were admitted from OPD [Out Patients Department] and COD [Casulty Department]. The patients were evaluated fully after history, clinical examination and specific investigation, blood CP, X-Ray abdomen, supin and erect posture, X-Ray KUB, ultra sound of abdomen and general assessment. All Patients of pain in right iliac fossa included all patients were manage on the basis of Alvarado score, Complete Blood Picture and Ultra Sound report. In this study 50 patients of acute appendicitis in which 25 were female and 25 were male. The maximum of patients were in age group 15 to 40 years. Peak age group 25 years. Out of 50 patients 42 patients were present leucocytosis. On the behalf of Ultra sound report 38 patients were diagnose acute appendicitis. 10 patients were diagnose perforated appendix, 2 patients were diagnose appendicular abscess. 8 patients were present Alvarado score 3 to 4.30 patients were present Alvarado score 6-7, 12 patients were present Alvarado score 8-9, Patients were operated through procedure of appendectomy then tissue sent for histopathology. Acute appendicitis is a common cause of acute abdomen. Anorexia, migrating pain, tenderness and rebound tenderness are evidence of acute appendicitis

Frequency of malignancy in benign enlarge prostate at peoples medical college hospital Nawabshah

To determine the frequency of Malignancy in Benign enlarge prostate. Prospective observational study: Two years study from October 2008 to October 2010. Was conducted in Peoples Medical College Nawabshah. The study comprises 50 patients all were admitted from OPD [Out Patients Department]. The patients were evaluated fully after history, clinical examination DRE and specific investigation of PSA X-ray Lumbo sacral spine Trans rectal, Endo luminal ultra sound flow metery Trans rectal biopsy C.T scan and Bone scan and General assessment. All Patients with enlarged prostate included out of 50 patients 48 patients under went surgery and tissue sent for histopathology. In this study of 50 patients of enlarge prostate total number of patients were in age group 55 to 75 years, Out of 50 patients 9 patients suspected malignant on the basis of DRE. But PSA will raise in 7 patients. Regarding the histopathology the results 7 patients showed malignancy adeno carcinoma. Prostate carcinoma more common enlarged prostate as compared to fibro tic prostate

Conservative lateral internal anal sphincterotomy versus topical diltiazem in the management of chronic anal fissure

To compare and assess the efficacy of conservative lateral internal sphincterotomy with topical diltiazem in the management of chronic anal fissure. Quasi experimental. Surgical Unit IV, Liaquat University of medical and health sciences, Jamshoro from 1st March 07 to 31st August 08. In total, 70 patients were included in the study and were divided into two groups. Group A was prescribed topical diltiazem whereas group B underwent conservative lateral anal sphincterotomy. Patients were followed up at 2nd, 4th and 8th week. The markers of efficacy were pain relief, healing of fissure, incontinence and recurrence. Data was collected on a questionnaire and was analyzed statistically using SPSS version 10. The p values were calculated using chi-square test and were considered significant below 0.05. Conservative lateral internal anal sphincterotomy produced a statistically significant response in comparison with topical diltiazem in terms of pain relief at first follow up [p=<0.001]. It was also associated with a better response rate of healing of fissure at the end of study and recurrence rates [p=0.002, 0.019]. However, at the end, topical diltiazem was associated with symptomatic relief in study population that was statistically insignificant [p=0.033]. Also patients who underwent conservative lateral internal sphincterotomy, 3 of them developed transient incontinence. None of the patients in diltiazem group experienced fecal incontinence. Conservative lateral internal anal sphincterotomy remains the modality of choice in the management of chronic anal fissure as it provides early pain relief, better healing rates and minimum number of recurrence. However, topical diltiazem can be prescribed as first line of management since it is non-invasive and is free of complications associated with surgical division of internal anal sphincter

Outcome of the rubber band ligation with Milligan Morgan haemorrhoidectomy

Haemorrhoids is a common anorectal disease seen in our society. Conservative management is usually adopted for 1[st] and 2[nd] degree haemorrhoids. Patients who do not respond to above management are the candidates for other modalities of treatment which includes sclerotherapy, rubber band ligation, cryosurgery and stapler gun or open haemorrhoidectomy. The purpose of study was to compare the outcome of the Rubber band ligation with Milligan Morgan haemorrhoidectomy in patients with 2[nd] and 3[rd] degree haemorrhoids. Hundred diagnosed admitted patients of uncomplicated 2[nd] and 3[rd] degree piles were treated either with rubber band ligation [RBL] or open method of Milligan Morgan [OH] for the period from January 2007 to December 2007 were included in the study. Both procedures were evaluated regarding effectiveness, safety, complications after procedures, hospital stay and return to work on a written Performa. Patients with 1[st] and 4[th] degree haemorrhoids, below the age of 12 years, bleeding diathesis, associated local anorectal conditions requiring surgery, complicated haemorrhoids, recurrent and secondary haemorrhoids were excluded from the study. Follow up of all these patients was done in OPD to assess any complication and recurrence. Data was analysed through SPSS-16.0. One hundred indoor patients with 2[nd] and 3[rd] degree haemorrhoids were treated either with rubber band ligation or open technique. Most [>90%] of the patients were males. Majority of the patients were in 30-33 years age group. Fresh bleeding [90%] and constipation [45%] were the commonest symptoms followed by prolapsed, discharge and irritation. Second degree was more common than 3[rd] degree haemorrhoids. Intensive pain was the commonest complain after both the procedures, however faecal incontinence was not reported in either group. Hospital stay was longer in open technique [70%] compare to few hours to one day in rubber band ligation group. Return to work was earlier in patients treated with rubber band ligation. Rubber band ligation is safe and effective method compare to open technique in 2[nd] and 3[rd] degree symptomatic haemorrhoids

Pilonidal sinus: excision with primary midline closure versus open method

Objective: To compare the efficacy of primary closure versus open method after excision of pilonidal sinus

Design: Comparative study

Setting: Department of Surgery Liaquat University of Medical and Health Sciences, Jamshoro, Sindh - Pakistan, from January 2003 to December 2006 [4 years]

Material and Methods: Cases of chronic pilonidal sinus were included in this study whereas acute sinuses and recurrent sinus were excluded. Patients were conveniently selected for excision with closure and without closure [group A and group B]. Both groups were followed up for 18-months. Efficacy assessed and compared on the basis of operating time, duration of postoperative hospital stay, time off work and recurrence rate

Results: Each group comprised of 20 patients. The mean age of all 40 patients was 27-years [17-42 years]. Males were 37 [92.5%] and females were 3 [7.5%]. Respective observations for both groups were mean operative time 91 min [85-95 min] and 69 min [60-75 min], mean postoperative hospital stay 6 days [4-8 days] and 11 days [9-13 days], mean time of wound healing was 11 days [9-13 days] and 39 days [19-42 days], mean off work time was 21 days [10-26 days] and 42 days [22-46 days]. Recurrence rate was 11.1% and 5.2% in group A and group B respectively

Conclusion: Though it takes longer to excise pilonidal sinus with primary closure and it has higher recurrence rate, it appears more beneficial due to reduced hospital stay, reduced healing time and early return to work

Frequency of malignancy in solitary nodule and multinodular goiter

To determine the frequency of malignancy in solitary nodule as well as multinodular goiter. Prospective observational study. Two years study from November 2006 to October 2008 was conducted in Liaquat University Hospital, Jamshoro and People's Medical College Hospital, Nawabshah. The study comprises 50 patients. All were admitted from OPD of both hospitals. The patients were evaluated fully after history and examinations and specific investigations of thyroid profile, scan, FNAC, indirect laryngoscopey and general assessment. All patients with solitary nodule and multinodular goiter included. Out of 50 patients 49 underwent surgery and tissue sent for histopathology. In this study of 50 patients of nodular goiter, 42 [84%] were female and 8 [16%] were male. The maximum number of patients were in age group 16-70 years. In 27 patients of multinodular 24 were female and 3 male. In 23 patients of solitary nodule 18 were female and 5 male. Regarding the histopathological results 10 [20%] patients showed malignancy, 8 [16%] in solitary nodules and 2 [4%] in multinodular goiter. Papillary.carcinoma seen in 7 [14%], follicular carcinoma in 2 [4%] and 1 [2%] as anaplastic carcinoma. Thyroid malignancy more common in solitary nodule as compared to multinodular goiter

Outcome and management of abdominal trauma at Liaquat University Hospital Jamshoro and Peoples Medical College Nawabshah

Out come and Management of Abdominal Trauma. Prospective observational study. Two years study from September 2006 to December 2008. Was conducted in Liaquat University hospital Jamshoro and Peoples Medical College Nawabshah. The study comprises 50 patients all were admitted from COD [Casualty out Patient: Department] of both hospitals. The patients were evaluated fully after history, clinical examination and specific investigation of X-ray abdomen supine and erect posture ultra sound of Abdomen contrast C.T and D.P.L Diagnostic Peritoneal Levage and General assessment. Al Patients of abdominal trauma included out of 50 patients 46 [92%] Patients an Underwent surgery Laparotomy. In this study of 50 patients of penetrating abdominal trauma 42 [84%] were males and 8 [16%] were Females the maximum number of patients were in age group 16 to 7 years in 40 [80%] Patients had fire arm, were the 6 [12%] cases of stab injury while remaining were the 4 [8%] of Blunt Trauma. Small intestine was the commonest organ injured 13 [26%] fallowed by liver 12 [24%] large intestine 7 [14%], Splenic injury was 7 [14%], Stomach 6 [12%], pan crease in 3 [6%], renal 2[4%]. Abdominal trauma is a serous emergency after Penetrating injury compared Blunt trauma

Frequency of hypocalcaemia in thyroid surgery

To determine the frequency of hypocalcaemia in thyroid surgery. This prospective study has been conducted at Surgical-IV in Liaquat University Hospital, Jamshoro/Hyderabad and Surgical Unit-II in Peoples Medical College, Nawabshah over a period of Two years from February 2006 to January 2008. This is a hospital based case series of 100 patients, who underwent subtotal, near total and total thyroidectomy for benign and malignant thyroid lesions. The age of the patients ranged between 15-70 years with mean age 32 years. 85 patients are female and 15 are male. In 18 patients, out of 100, hypocalcaemia has been observed clinically as well biochemically. It is concluded that frequency of hypocalcaemia is significant but only a few of them present with symptoms and permanent hypoparathyroidism is very rare

Clinical pattern and management outcome of phyllodes tumor of breast

To determine the clinical and histopathological pattern, surgical protocol and need of adjuvant therapy for phyllodes tumour of breast Case series. Surgical department of Liaquat University Hospital Jamshoro, from November 2000 to October 2006. All female patients with phyllodes tumor of breast diagnosed after triple assessment were included. Non probable purposive sampling technique was used. Female having carcinoma breast were excluded. After taking consent data related to age, parity, site, size of tumor, treatment options, histopathology and metastatics work up done [in case of malignant disease]. Patients were advised follow up for minimum period of two years. Data was collected on proforma and analysed by SPSS version 10. A total of 35 patients with phyllodes tumor were studied. Out of these 23[67.5%] were benign, 5[14.3%] were borderline and 7[20%] were malignant. Mean age was 24 years. All patients were assessed by triple assessment. Nine[25.7%] patients had lumpectomy and 26[74.3%] underwent mastectomy. Patients with proven malignancy and borderline disease on histopathology were submitted for adjuvant chemoradiotherapy. Patients were followed for minimum period f two years. There was one recurrence after lumpectomy among benign disease [16.66%] while there was no recurrence after mastectomy with or without chemoradiotherapy. Phyllodes tumor must be vigorously treated with wide local excision or mastectomy followed by adjuvant chemoradiotherapy in malignant or borderline tumor to minimize recurrence

Frequency of hodgkin's lymphoma in patient with cervical lymphadenopathy presenting in a public hospital in Pakistan

Objectives: To determine the frequency and pattern of presentation of Hodgkin's lymphoma in cervical lymph node at Liaquat University Hospital, and to see its pathological variants. Study design: Case series. Study Setting: Surgical departments of Liaquat University Hospital. Study Duration: Five years from January 2000 to December 2004

Sampling: Non-probable purposive. Inclusion Criteria: All patients of cervical lymph node enlargement of more than four weeks duration irrespective of age and sex. Exclusion Criteria: Cervical lymph node less than 1cm. Study Variables: Study variables used were age, sex, symptom, clinical finding, stage and histopathology. Data Analysis: Data analysis was done by using SPSS version 10

Results: A total of 500 patients with enlarged cervical lymph nodes were studied, amongst them 40 [8%] patients were diagnosed with Hodgkin's lymphoma [32 males and 8 females]. Mean age of 40 patients was 23 years [range 9-44 years]. Out of these 40 patients, in 8 [20%] patients it was difficult to differentiate lymphoma clinically from tuberculosis on clinical examination. Cervical swelling was the commonest symptom [100%] while fever, night sweats and weight-loss were present in 45% patients, 55% of patients were in stage III and IV [advance disease]. Mixed cellularity was the commonest histological variant. All 40 patients after diagnosis and staging were referred to Nuclear Institute of Medical Radiotherapy for further management

Conclusion: Although tuberculous cervical lymph node enlargement is very common, but Hodgkin's lymphoma has a definite possibility of occurrence [8% in our study]. Therefore all patients with enlarged cervical lymph node should not be treated with anti-tuberculosis therapy on empirical basis. Diagnosis should be confirmed by biopsy, otherwise patients may land up with advanced stage of Hodgkin's lymphoma with poor prognosis

audit of renal cell carcinoma at Hyderabad

To audit the patients of Renal Cell Carcinoma treated in Surgical Unit-IV, Liaquat University Hospital Jamshoro, Hyderabad. Prospective interventional study conducted from Jan. 2000 to Dec. 2004. Department of Surgery, Liaquat Medical University Hospital, Jamshoro. All patients who presented with Renal Cell Carcinoma during the study period. The history and examination findings of all these patients was recorded. Complete blood picture, urine analysis, liver function tests, ultrasound abdomen, IVU and CT scan was done in all the cases. Staging was done according to the TNM classification and surgery performed in fit patients. A total of 39 cases of Renal Cell Carcinoma were seen during the study period, with a male to female ratio of 3.3:1 and a mean age of 46 years. Most [61.53%] patients presented with a mass in the abdomen; 51.28% were in Stage-II and 25. 64% in stage-III. Thirty four [87.18%] cases were operated, the rest being unfit. Radical nephrectomy was done in 51.28% cases, simple nepherectomy in 10.26%, debulking surgery in 20.51% and biopsy only in 5.13% cases. Three [8.8%] patients died due to postoperative complications. Radical surgery is the curative treatment for Renal Cell Carcinoma. Cases should be diagnosed early in order to decrease the morbidity and mortality of the disease

Minicholecystectomy: review of 200 cases

A prospective study of 200 cases of cholelithiasis who underwent minicholecystectomy was conducted at surgical unit-IV of Liaquat Medical College Hospital, Jamshoro and other private hospitals over a period of three years from January 1996 to December 1998. Female patients were 89 percent. Youngest patient was 21 years of age while oldest was of 80 years, mean age being 42 years. Operating time varied between 24 minutes to 70 minutes, with average time 35 minutes. Twelve percent of cases presented with acute cholecystitis and adhesions, 10 percent of cases presented with mucocele and 8 percent with empyma gall bladder. Post-operatively, 22 percent of cases developed complications. Amongst these, 9 percent of cases developed primary hemorrhage, 3 percent of cases bile leakage, 5 percent developed wound sepsis, 4 percent complained of painful scar and bile duct injury developed in 1 percent of cases. All the complications were transient and mortality was zero

Evaluation of morbidity and recurrence in bilateral repair of inguinal hernias

A prospective study of bilateral repair of 100 cases of inguinal hernia was carried out from January, 1996 to January 1998 at Liaquat Medical College Hospital [LMCH], Hyderabad. Age of presentation was between 16 years to 70 years, with mean age 43 years. Common presentation was swelling in groin and dragging pain during walking. Forty percent of patients had -indirect inguinal hernias, 45 percent had direct and 10 percent of cases had direct hernia on one side and indirect on other side. In most of the cases repair was done with Bassini's technique. In 20 percent of cases suprapubic skin crease incision was made and in 80% of cases two separate incisions were made. Hospital stay was between 2 to 14 days with average of 5 days. Post-operative complications were haematoma 8 percent, penile oedema 6 percent, wound sepsis 4 percent, Hydrocele 6 percent and recurrence rate in 4 percent of cases. Mortality was 0%. This study shows little difference in morbidity and recurrence in bilateral repair as compared to stage one side repair in bilateral inguinal hernias

Empyaema of gall bladder-results of early cholecystectomy

Over a period ranging from January 1992 to January 1994, 65 cholecystectomies were performed for empyaema of gall bladder. A palpable gall bladder mass was found in only 34 [2.31%] patients and a positive ultrasound examination in 36 [55.38%] patients. Early cholecystectomy is recommended as the treatment of choice as there is no mortality and low morbidity